Organization Information * Required Information

Name of Organization* 

Contact Person's First Name*
Contact Person's Last Name*


Number of participants expected*

In order to customize the workshop to fit the interests of your organization and audience, please address the following questions:

1. What are the mission and goals of your organization?

2. Who are members of the audience (i.e., majors, class level, interests,
etc.), and proposed set up of the workshop (if you have a panel, please
indicate names and offices represented by other panelists)?

Workshop Information

Proposed Workshop Title 

List three possible workshop dates and times in order of preference.  Workshop dates must be at least two weeks after the submission of this form.

   Date   Start Time   Duration 
1. / /
2. / /
3. / /

Proposed Location 

If audio/visual equipment is needed for the presentation, please specify
your preference below:

  Organization can provide the equipment.
  Organization would like UROP to provide the equipment.

Double-check that your information is correct,
 then click the Continue button